Talking it Out

If a type of counseling is not right for a person, it can actually harm their mental health.

Monica Drake was about 5 years old when she had her first panic attack.

One of the earliest she can remember happened in the middle of the night. She saw specks of light and the room began to spin. She started to hyperventilate and felt like the walls were closing in around her. She thought she was being possessed or maybe God was punishing her. She was scared for her life without knowing why. These experiences continued throughout Monica’s adolescence, like nightmares while she was awake.

Monica, now a 29-year-old, was officially diagnosed with anxiety and panic disorder at age 19. According to the National Institute of Mental Health, mental disorders affect a little more than 18 percent of America’s adult population. But this experience is different for each person, and treatments that work for one person might not work for another.

Mental illness is treated like most physical ailments: with medication, therapy, or a combination of the two. Once diagnosed, patients can begin a treatment process tailored to their needs and the ways they respond most effectively. According to psychologist Dr. Brandon Robbins, treatment type varies because illnesses can be caused by any number of factors, like genetics or trauma.

Monica didn’t know what she was experiencing had a name until she was 19. She started seeing a Christian psychiatrist after a bad break up, which had triggered her anxiety and worsened her panic attacks.

Monica didn’t feel like she could really talk about her problems with this counselor, though. She found it hard to be vulnerable and speak her mind because the therapist put everything into a religious perspective. The counselor would often make her feel guilty for having anxiety, so Monica stopped talking about her life. Eventually, the counselor said Monica was “fine” and didn’t need to come back.

Monica’s first therapy experience didn’t help her understand what was wrong. It wasn’t the right fit for her.

Shortly after ending her treatment, Monica began working as a receptionist at a psychiatrist’s office. The psychiatrist noticed her symptoms, told her she was suffering from anxiety and panic disorder, and prescribed her medication. With the medication, Monica finally noticed a change. She started feeling better.

Psychotherapy, treatment that involves both counseling and medication, does have its drawbacks. Dr. John S. Grohol, a doctor of psychology and CEO of PsychCentral, published an article in 2008 that listed some disadvantages of psychotherapy. He said the effects can be unpredictable and it also takes a while to see change. As he puts it, 50 minutes is not a lot a time. These factors can deter people from reaching out to therapists.

We Need To Talk Coalition, a group that advocates for better access to psychotherapy for those who need it, conducted a survey in 2014 to study the effectiveness of various counseling methods. Of the 2,000 participants who had tried to access therapy in the last two years, 50 percent didn’t attend enough sessions to fully recover. The same amount waited more than three months to be assessed for treatment in the first place, and one in 10 waited at least a year.

Factors like patience, attention, time, and motivation can make counseling more effective, but the most important is trust. According to Dr. Robbins, a significant amount of positive results come from the bond forged between patient and therapist. Patients must have a safe space where they can be vulnerable to a person they trust, and a counselor must be that for them.

This is likely why Monica’s first therapy sessions didn’t help her. She couldn’t feel safe talking with that counselor. She didn’t trust her.

According to Dr. Robbins, psychologist’s techniques play a very small role in the effectiveness of the treatment—about 15 to 20 percent—compared to the patient’s feelings of safety. So it wasn’t necessarily that Monica’s counselor didn’t do her job. It just wasn’t the right treatment for her.

Monica did have one advantage over most others—her mother’s help. After the bad breakup, Monica told her mom about the feelings of anxiety and her mom at least tried to find help for Monica, even if it wasn’t as helpful as she might have hoped.

Dr. Robbins says it’s common for people who have a mental illness to not tell loved ones about their condition. They might be afraid that having a mental illness means they failed their parents or friends, they aren’t trying hard enough, or that the illness is their fault.

Monica felt that way when she started taking medication, but when she learned that her attacks were part of a legitimate illness and that they actually weren’t her fault, she began feeling better.

Even then she didn’t tell her parents about the medication until her mom found it in Monica’s purse. Monica’s mother said Monica shouldn’t tell her father because it would devastate him.

Someone with a mental disorder might experience many emotions, including shame. Dr. Robbins describes this as a “chicken-or-the-egg” phenomenon: Do negative emotions cause the mental disorder, or does the mental disorder cause the emotions?

Monica says it’s both. Until finding a way out, she was stuck in a cycle of anxiety and shame. That’s why she didn’t want to share that she was taking medication.

Monica’s most effective form of relief came through her work at a newspaper. She began reporting about teenagers who had died by suicide because of mental illness. The stories made her sad, but they also made her feel less alone.

After realizing how many people had experiences like hers, Monica started writing a blog to share her story with others who might be struggling. She still takes medication for her anxiety and panic attacks, but they come less frequently now—every six months or so instead of every week.

She’s also learned to talk to her friends, family, and professional psychologists about how she’s feeling, and they’ve all become part of the support system she uses to get through her anxiety. Through a series of trial and error, Monica learned what works for her.